Background

To determine the association between early infection risk factors and short-term outcomes in infants with neonatal encephalopathy following perinatal asphyxia (NE).

Methods

A retrospective population-based cohort study utilizing the National Neonatal Research Database that included infants with NE admitted to neonatal units in England and Wales, Jan 2008–Feb 2018. Exposure: one or more of rupture of membranes >18 h, maternal group B streptococcus colonization, chorioamnionitis, maternal pyrexia or antepartum antibiotics. Primary outcome: death or nasogastric feeds/nil by mouth (NG/NBM) at discharge. Secondary outcomes: organ dysfunction; length of stay; intraventricular hemorrhage; antiseizure medications use.

Results

998 (13.7%) out of 7265 NE infants had exposure to early infection risk factors. Primary outcome (20.3% vs. 23.1%, OR 0.87 (95% CI 0.71–1.08), p = 0.22), death (12.8% vs. 14.0%, p = 0.32) and NG/NBM (17.4% vs. 19.9%. p = 0.07) did not differ between the exposed and unexposed group. Time to full sucking feeds (OR 0.81 (0.69–0.95)), duration (OR 0.82 (0.71–0.95)) and the number of antiseizure medications (OR 0.84 (0.72–0.98)) were lower in exposed than unexposed infants after adjusting for confounders. Therapeutic hypothermia did not alter the results.

Conclusions

Infants with NE exposed to risk factors for early-onset infection did not have worse short-term adverse outcomes.

Impact

• Risk factors for early-onset neonatal infection, including rupture of membranes >18 h, maternal group B streptococcus colonization, chorioamnionitis, maternal pyrexia or antepartum antibiotics, were not associated with death or short-term morbidity after cooling for NE.

• Despite exposure to risk factors for early-onset neonatal infection, infants with NE reached oral feeds earlier and needed fewer anti-seizure medications for a shorter duration than infants with NE but without such risk factors.

• This study supports current provision of therapeutic hypothermia for infants with NE and any risk factors for early-onset neonatal infection.

中文翻译：

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新生儿脑病婴儿感染的危险因素和结局：一项队列研究

背景

确定围产期窒息（NE）后患有新生儿脑病的婴儿的早期感染危险因素与短期结局之间的关联。

方法

利用国家新生儿研究数据库进行的一项基于人群的回顾性队列研究，包括 2008 年 1 月至 2018 年 2 月入住英格兰和威尔士新生儿病房的 NE 婴儿。暴露：一次或多次胎膜破裂 > 18 小时，母体 B 型链球菌定植、绒毛膜羊膜炎、产妇发热或产前抗生素。主要结局：出院时死亡或鼻饲/无经口喂养 (NG/NBM)。次要结局：器官功能障碍；停留时间;脑室内出血；抗癫痫药物的使用。

结果

7265 名 NE 婴儿中有 998 名 (13.7%) 接触过早期感染危险因素。主要结局（20.3% vs. 23.1%，OR 0.87 (95% CI 0.71–1.08)，p  = 0.22）、死亡（12.8% vs. 14.0%，p  = 0.32）和 NG/NBM（17.4% vs. 19.9%） .p = 0.07）暴露 组和未暴露组之间没有差异。调整后，暴露婴儿的完全吸吮喂养时间（OR 0.81 (0.69–0.95)）、持续时间（OR 0.82 (0.71–0.95)）和抗惊厥药物数量（OR 0.84 (0.72–0.98)）均低于未暴露婴儿。混杂因素。低温治疗并没有改变结果。

结论

暴露于早发型感染危险因素的 NE 婴儿并没有出现更严重的短期不良后果。

影响

• 早发新生儿感染的危险因素，包括胎膜破裂 >18 小时、母体 B 型链球菌定植、绒毛膜羊膜炎、母体发热或产前抗生素，与 NE 降温后的死亡或短期发病无关。

• 尽管暴露于早发性新生儿感染的危险因素，但与没有这些危险因素的 NE 婴儿相比，患有 NE 的婴儿更早开始经口喂养，并且需要更少的抗癫痫药物，持续时间更短。

• 这项研究支持目前为患有 NE 的婴儿和任何早发新生儿感染的危险因素提供低温治疗。